Onions, spicy dishes, and fried foods have gotten a bad rap. While there’s some evidence these foods can trigger heartburn, experts say how you eat is more important than what you eat when it comes to controlling painful flare-ups.
“The old adages about onions and fruit juice and things like that—those foods are not as problematic as we used to think,” says Michael D. Brown, MD, a professor of medicine and digestive diseases at Rush University Medical Center in Chicago. “When I talk to patients now, we talk about how much they eat and how they eat it, not what they eat.”
Other experts agree. “The evidence to support eliminating certain foods to reduce the symptoms of heartburn is not strong,” says Nyree Dardarian, MS, RD, director of the Center for Integrated Nutrition and Performance at Drexel University.
So what is causing your heartburn? Brown says heartburn is a symptom of acid reflux, or the bubbling up of stomach acids into your esophagus. Your esophagus—which connects your throat to your stomach—isn’t designed to handle those acids, so reflux creates a painful burning sensation.
“Almost everybody experiences heartburn once in a while,” Brown says. “But if it happens often—4% of the time or more—then you have GERD, or gastroesophageal reflux disease.” Brown says that 4% figure comes from clinical research linking heartburn frequency to trouble swallowing, tooth enamel erosion, throat problems, and more serious issues like asthma or even pulmonary injury.
While specific foods may still trigger heartburn for some people, Brown and Dardarian say there are more important factors raising your risk for the painful post-meal condition:
1. Chowing down too close to bedtime (or naptime)
“Eating within 2 to 3 hours of lying down is a problem,” Brown says. Your body can only do so much to fight gravity. And if you’re hitting the sack on a full stomach, you’re helping the contents of your belly slide up into your esophagus, he says. Especially for people diagnosed with GERD, eating before lying down is a no-no, shows research from Japan. Even sitting back or reclining too soon after a meal could trigger heartburn, Dardarian says.
2. Eating large or too-frequent meals
The more food you pack into your stomach, the more likely some of it is to sneak its way up into your esophagus, suggests a recent study from Canadian, Australian, and Iranian researchers. Eating frequently and at odd intervals also seem to bring on the burn, Dardarian says.
3. High BMI
Carrying excess weight slows the speed of food though your digestive system, creates more pressure within your abdomen, and also loosens the “sphincter” muscle that keeps your stomach contents out of your esophagus, concludes a study from the Annals of Internal Medicine. All of those may explain the link between heartburn and a high BMI, the study authors say. “Reduction in weight through lifestyle modifications such as meeting with a registered dietitian, eating less, and moving more may be the best solutions to reduce the pain,” Dardarian says.
4. You drink too much
“Alcohol is thought to relax the lower esophageal sphincter, a muscle that helps keep the contents of your stomach in your stomach,” Dardarian says. Especially if you’re drinking just before bedtime—and coupling that last glass of wine with a pre-bed snack—you’re asking for trouble.
5. You eat the wrong foods.
Yes, research has linked onions, spicy foods, and soda to heartburn. But those triggers aren’t universal. “If you have bad symptoms when you eat something, by all means, don’t eat it,” Brown says. But the idea that acidic foods will drive up your stomach acid and cause heartburn is problematic. “The thing about acid in food is that it’s minuscule compared to what’s already in your stomach,” Brown says. “Your stomach makes about two liters of hydrochloric acid a day to break down what you eat, so high-acid foods aren’t going to make much of a difference.”
So, What Foods Should You Eat?
Apart from avoiding those foods that set off your heartburn (duh), “a diet that contains lots of fiber, legumes, and vegetables, as well as olive oil and other components of Mediterranean-style diets, seems to be protective against GERD and heartburn,” Brown says. Substituting water for carbonated beverages like soda also seems to be helpful, Dardarian says.